Every finding on record at Adventa Hospice, LLC

Upon patient record review 1 of 23 (Patient #9) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #9: There is evidence in the medical record the patient was admitted on 11/25/24 and the psychosocial comprehensive assessment was completed on 12/2/24 which is greater than 5 days.

Upon patient record review, 2 of 23 (Patient #5,8) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #5: Observed on home visit, the hospice medication record listed Oxygen 2L/NC. Oxygen was not in the home. (corrected on site) Patient #8: Benadryl 25 mg every 6 hrs. as needed was on the hospice medication record and not on the facility medication record. (corrected on site)

Upon patient record review, 1 of 23 (Patient #8) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #8: There is evidence in the medical record of a new wound assessed on 10/31/24 and no documentation of assessment until it was inactivated on 12/10/24. There was not a weekly assessment of the wound, as required by the hospice wound care policy.

Upon patient record review, 1 of 23 (Patient #1) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #1:There is evidence in the record of an add-on order on 10/28/24. The order identifies the care plan interventions and goals but does not contain the frequency of visits. (corrected on site)

Upon client record review, 1 of 23 (Patient #9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #9: There is evidence in the medical record of an add-on order on 12/18/24, MSW effective 12/1/24, 5M1, 4M1, 2M1 and 2 PRN for social support. In December 2024, the visit dates were 12/2/24 PRN visit; 12/18/24 Evaluation visit.

Upon home visit observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #9: Observed during home visit, the RNCM placed used pulse oximeter touching the clean blood pressure cuff. He did not maintain adequate areas for clean and dirty equipment.

Upon patient record review, 2 of 23 (Patient #2,5) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #2: There is evidence in the Plan of Care that the patient is on seizure precautions. Seizure precautions is not on the aide plan of care. (corrected on site) Patient #5: There is evidence in the Plan of Care that aspirations were added on 1/18/25. The aide plan of care was not updated to include aspiration precautions. (corrected on site)

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. There is evidence in the cost savings report for 2024 of 1.25%. The hospice started a PIP in June 2024 to improve volunteer recruitment.

Upon patient client record review, 1 of 23 (Patient #1) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #1: There is evidence in the medical record on 12/20/24 of a RNCM supervisory visit for the LPN. The LPN had not made any visits.

Upon client record review, 1 of 23 (Patient #8) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient #8: There is evidence in the medical record the patient resides in a SNF. On 10/31/24 an order for wound care for coccyx did not indicate who would change dressing.

Based on agency policy review, medical record review and interview, the agency failed to complete a thorough initial comprehensive assessment, to include a wound assessment, for 1 patient (#4) out of 14 patients reviewed. The findings include: Review of the agency policy Assessments with a revised date of 11/2019, showed "...The Hospice conducts patient specific assessments at the time of admission...The comprehensive assessment identifies the physical...needs...related to the terminal illness that must be addressed in order to promote the hospice patient's wellbeing, comfort, and dignity..." Review of the agency policy The Provisions of Wound and Skin Care with a revised date of 1/2022, showed "...Orders: Wound care orders are in effect until documentation supports wound care is no longer needed or an order is received to change the wound care or discontinue it...Measuring: wounds will be measured a minimum of one time a week..." Medical record review revealed Patient #4 was admitted to the agency on 1/15/2022 with diagnoses of Hypertensive Heart Disease with Heart Failure, Congestive Heart Failure, and Chronic Kidney Disease. Record review of Patient #4's Plan of Care (POC) with the certification period of 1/15/2022- 4/14/2022 revealed "...SN [Skilled nurse] 1 [time] WEEK..." Record review of an initial nursing assessment Visit Note Report dated 1/15/2022 showed, "...INTEGUMENTARY...INDICATE INTEGUMENTARY ASSESSMENT FINDINGS: (MARK ALL THAT APPLY)...BRUISING...PALE...PETECHIAE...POOR TURGOR..." No documentation that Patient #4 had a wound. Record review of a nursing Visit Note Report dated 1/19/2022 showed no documentation that Patient #4 had a wound. Record review of a nursing Visit Note Report dated 1/27/2022, showed "...INTEGUMENTARY...INDICATE INTEGUMENTARY ASSESSMENT FINDINGS: (MARK ALL THAT APPLY) ...WOUND...COCCYX, PU [Pressure Ulcer] STAGE III...Onset Date: 1/03/2022...LENGTHxWIDTHxDEPTH(CM)...3 X 1.8 X 0.2..." Further review showed wound care had been provided. Record review of a nursing Visit Note Report dated 1/31/2022, showed "...INTEGUMENTARY...WOUND CARE PROVIDED ON BUTTOCKS STAGE 3 PRESSURE ULCER..." No documentation of Patient #4's wound measurement. Record review of a nursing Visit Note Report dated 2/2/2022, showed "...wound care not provided: refused care..." No documentation of Patient #4's wound measurement. Record review of a nursing Visit Note Report dated 2/7/2022 showed no documentation of Patient #4's wound or wound measurement. Record review of a nursing Wound Record Report dated 2/10/2022 showed "...WOUND...COCCYX, PU [Pressure Ulcer] STAGE III...INACTIVATED 2/10/2022...Previously documented wounds inactivated rt [related to] being resolved, patient educated regarding skin care including the use of barrier cream..." During an interview with the Director of Operations on 2/16/2022 at 9:41 AM, confirmed the agency failed to assess Patient #4's wound on the initial assessment. She also confirmed the agency failed to measure the wound weekly.

Based on agency policy review, medical record review, and interview the agency failed to update the medication profile for 1 patient (#12) of 3 patients reviewed with home visits. The findings include: Review of the agency's policy Medication Management with a revised date of 12/30/2021 showed, "...Medication Profile...The medication plan of care (POC) will include all prescription and over the counter medication...medication profile will be updated as modifications are made...Medication Reconciliation will be done at recertification...when a medication is discontinued, when a medication is a new order, or a change in existing medication order..." Record review showed Patient #12 was admitted to the agency on 5/24/2021 with diagnoses to include Alzheimer's Disease, Chronic Kidney Disease, Stage 4, and Malignant Neoplasm of Colon and Right Ovary. Further review showed the patient resided in a local Assisted Living Facility (ALF). Record review of Patient #12's agency medication profile showed the following Physician Orders: . Lorazepam (medication used to treat anxiety) 1 Milligram (MG) tablet, give half of 1 MG tablet (0.5 MG) 3 times daily as needed (PRN) dated 9/14/2021. . Melatonin (medication used for insomnia) 10 MG tablet, 1 tablet at bedtime dated 8/13/2021. . Seroquel (medication used to treat psychiatric disorders) 25 MG tablet, 1 tablet at bedtime dated 8/13/2021. Record review of Patient #12's current ALF Physician's Orders showed: . Lorazepam 0.5 MG tablet, take 1 tablet by mouth every 6 hours PRN dated 9/14/2021. . Melatonin 5 MG tablet, take 3 tablets at bedtime dated 2/9/2022. . Quetiapine (Seroquel) 25 MG tablet, take 1 at 12 PM and 2 tablets at bedtime dated 10/20/2021. . Acetaminophen (Tylenol) 325 MG tablet, take 1-2 tablets every 4-6 hours PRN dated 8/20/2021. . Geri-Mox Suspension (medication used to treat indigestion), take 30 Millimeter (ML) by mouth PRN up to 4 times daily dated 8/20/2021. . Loperamide Liquid (medication used to treat diarrhea) 1 MG/7.5, take 4 teaspoons (20 ML) by mouth after each loose stool, not to exceed 8 teaspoons in 24 hours dated 8/20/2021. . Tylenol 500 MG tablet, take 1-2 tablets by mouth every 8 hours PRN dated 8/20/2021. . Milk of Magnesium Suspension (medication used to treat constipation, upset stomach, and heartburn), take 30 ML by mouth PRN dated 8/20/2021. . Pepto-Bismol Suspension (medication used for upset stomach); take 30 ML by mouth PRN up to 3 times daily, dated 8/20/2021. During an interview on 2/16/2022 at 10:55 AM, the Director of Operations stated medication reconciliations should be completed weekly. She confirmed Resident #12's agency Physician Orders had not been reconciled with the ALF Physician Orders.